50 Ways for Your Arizona Workers’ Compensation Claim to Be Denied (and what to do about it).

Posted by Weston Montrose

After filing a claim for workers’ compensation benefits with the Industrial Commission of Arizona the employer’s insurance carrier will be “notified” of the claim. The insurance company is supposed to either “accept” or “deny” the claim within 21 days of receiving the ICA’s notification. If they deny the claim, they just have to check a box declaring that the claim is denied, they don’t have to list any explanation for their denial.

After receiving a denial without any explanation, an applicant for benefits will often ask “Can they do that?” The obvious answer is yes, that they can do that as evidenced by the fact that they have “done that.” The better question is “why did they do that?” I have compiled the following list of explanations for “why” a claim may have been denied (please note that each of the reasons may not be ultimately justified):

(Sung to the tune of 50 Ways to Leave Your Lover by Paul Simon)

1. Off site injury
2. Pre-existing condition
3. Independent Contractor
4. Failure to Forthwith Report
5. Late Reporting
6. Un-witnessed event
7. Late Filing
8. Domestic servant
9. Motion picture employee covered by 23-909 exemption
10. Real Estate licensee covered by 23-910 exemption
11. Out of state worker covered by 23-904(C)
12. Employer does not regularly employ anyone
13. Opted out of comp system
14. Self inflicted injury
15. Violation of Rule
16. Misconduct interrupting course of employment
17. Wrong employer
18. Idiopathic condition
19. Not an unusual, extraordinary, unexpected stressor for mental condition
20. Stressor not a substantial contributing factor to mental condition
21. Stress or exertion not a substantial contributing cause to heart injury
22. Hernia fails 23-1043 test
23. Abandonment of work by intoxication
24. Going/coming to work
25. Illegal Conduct
26. Valley Fever
27. Failure to report significant exposure (to body fluids)
28. Not dependent on decedent (death benefits)
29. Election of remedy – tort lawsuit
30. Failure to notify carrier of employment: Not covered by policy (PEO)
31. No coverage (policy lapse, etc.)
32. Improper Jurisdiction
33. No contract for hire
34. Personal Assault (no work friction involved)
35. Deviation from business trip
36. Personal comfort by unreasonable method or great deviation
37. Horseplay
38. Off premises recreational/social activity not sponsored or encouraged by employer
39. HIV fails 23-1043.02 test
40. Hepatitis C fails 23-1043.03 test
41. MRSA fails 23-1043.04 test
42. Bad Faith
43. Unexplained injury at time/place outside course of expected work duties
44. Lent employee
45. Volunteer worker
46. Refusal to attend a medical evaluation
47. Claim not filed until after being terminated
48. Refusal to grant a “recorded” statement
49. Refusal to sign a “medical release” to access medical records
50. Claim filed on Monday after weekend (or on day after days off work)

It’s extremely important that a claimant file a “protest” or “request for hearing” within 90 days of the date of the denial notice. If the deadline is missed without a legal excuse, it doesn’t matter whether the denial was truly justified or not. The claim will be forever deemed denied regardless of the merits. If you believe a claim is wrongfully denied you should contact a qualified attorney or take action on your own behalf immediately.

Here is a link for a Request for Hearing Form:

https://www.azworkcomplaw.com/wp-content/uploads/2023/03/Request-For-Hearing.pdf